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2020, vol. 148, br. 11-12, str. 701-705
Da li prema starosti korigovana vrednost skora MEWS pri prijemu ima prognostičku vrednost u odnosu na konačan ishod lečenja?
aInstitut za plućne bolesti, Sremska Kamenica + Univerzitet u Novom Sadu, Medicinski fakultet
bInstitut za plućne bolesti, Sremska Kamenica

e-adresadusanka.obradovic@mf.uns.ac.rs
Ključne reči: MEWS; laktat; BE; ishod
Sažetak
Uvod Bodovni sistemi za rano prepoznavanje su važni za identifikaciju kritično obolelih, ali da li su i prognostički alat? Cilj je bio proveriti prognostičku vrednost modifikovanog ranoupozoravajućeg bodovnog skora (MEWS), laktata i baznog ekscesa (BE) kod bolesnika primljenih u jedinicu poluintenzivne terapije. Metode Prospektivna opservaciona studija obuhvatila je 369 bolesnika hospitalizovanih u pulmološku jedinicu poluintenzivne terapije. Vrednosti MEWS skora, laktata i BE pri prijemu zabeležene su, kao i dob bolesnika, pol i prisustvo komorbiditeta. Negativni ishod je definisan kao smrt ili premeštaj u jedinicu intenzivnog lečenja. Faktori za koje je univarijantnom analizom utvrđena statistička značajnost analizirani uz pomoć multivarijantne logističke regresije, u cilju utvrđivanja nezavisnih prediktora nepovoljnog ishoda. Rezultati Od ukupno 369 bolesnika, 203 (55%) su bili muškarci, a prosečna starost je bila 62 ± 16 godina. Nepovoljan ishod lečenja zabeležen je kod 138 (37,41%) bolesnika: 27,37% je umrlo; a 10,03% bolesnika premešteno je u jedinicu intenzivnog lečenja. Prosečna dužina hospitalizacije bila je 13 dana (IQR 7-15). Bolesnici sa nepovoljnim ishodom imali su značajno veće vrednosti MEWS (3,68 ± 1,965 vs. 4,57 ± 2,33, p < 0,001), niži BE (-0,139 ± 7,48 vs. -3,751 ± 6,159, p < 0,001), i viši laktat (2,299 ± 2,350 vs. 3,498 ± 3,578, p < 0,001). MEWS ≥ 4 (OR 1,90, CI 1,082-3,340, p = 0,026) se izdvojio kao jedini nezavisni prediktor mortaliteta. Površina ispod krive (AUC) za MEWS u funkciji prediktora mortaliteta bila je 0,633 (95% CI 0,569-0,697). Korekcijom u odnosu na starost bolesnika, AUC je bila 0,76 (95% CI 0,707-0,814). Zaključak Rezultati studije potvrđuju prognostičku vrednost MEWS bodovnog sistema u odnosu na konačan ishod lečenja bolesnika jedinice poluintenzivnog lečenja.
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O članku

jezik rada: engleski
vrsta rada: originalan članak
DOI: 10.2298/SARH181008058O
primljen: 08.10.2018.
revidiran: 03.08.2020.
prihvaćen: 05.08.2020.
objavljen onlajn: 04.09.2020.
objavljen u SCIndeksu: 06.01.2021.